Periodontics
| D4210 | Gingivectomy/Gingivoplasty - Per Quadrant | $180.00 |
| D4211 | Gingivectomy/Gingivoplasty - Per Tooth | $50.00 |
| D4240 | Gingival Flap Procedure, Including Root Planing - Per Quadrant | $200.00 |
| D4260 | Osseous Surgery - Per Quadrant (Including Flap Entry and Closure) | $260.00 |
| D4341 | Periodontal Scaling and Root Planing - (Per Quadrant) | $75.00 |
| D4355 | Full Mouth Debridement | $70.00 |
| D4910 | Periodontal Maintenance Procedures Following Active Therapy | $30.00 |
A specific periodontic treatment may present unusual circumstances requiring an additional cost. Please consult the affiliated dentist as to the total procedure cost prior to treatment.